Advertisement

The BUPA ‘Decision Engine’: An Integrated Case Based Reasoning System at Work in the Private Medical Insurance Industry.

  • Daniel Kerr
Conference paper

Abstract

The Private Medical Insurance industry has long been an active user of information technology, for instance to assist with the complex task of managing insurance claims, determining conditions for cover and eligibility. In 1997 BUPA developed a ‘Decision Engine’, a series of interlinked case-bases that consult member and policy data to assist front-line call-centre decision making with regard to pretreatment authorisation. This business-critical system guarantees a consistent response to member requests with regard to what costs will be indemnified by BUPA. It also enables BUPA to provide information to members to allow them to make informed decisions and encourage specialists to carry out the most appropriate treatments. This paper looks at why the system has been a success and how work is being done to ensure that the system continues to be relevant to business needs and has the flexibility to be compatible with the developing corporate enterprise architecture.

Keywords

Case Base Enterprise Architecture Product Portfolio Financial Service Authority Decision Engine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Laing and Buisson. Laing’ s Healthcare Market Review 2002–2003. William Clowes Ltd Suffolk, 2002Google Scholar
  2. 2.
    Lees, B. (ed) Proceedings of 7th UK Workshop on Case-Based Reasoning. University of Paisley. 2002.Google Scholar
  3. 3.
    Association of British Insurers. ‘Are you buying private medical insurance?’ Available from www.abi.org.uk/Public/Consumer/Medical/ Google Scholar
  4. 4.
    Peter Saunders Associates. ‘The BUPA Administration Support System’. Consultants report for BUPA Membership Division. 1992.Google Scholar
  5. 5.
    Watson I. Applying Case-Based Reasoning: Techniques for Enterprise Systems. Morgan Kaufmann Publishers, San Francisco. 1997.MATHGoogle Scholar
  6. 6.
    Leake, D. ‘CBR in Context: The Present and Future’. In: Leake, D. (ed) Case-Based Reasoning: Experiences, Lessons and FutureDirections. AAAI Press/MIT Press, Menlo Park. 1996.Google Scholar
  7. 7.
    Sengupta, A., Wilson, D. and Leake, D. ‘Constructing and Transforming CBR Implementations: Techniques for Corporate Memory Management’. In: Proceedings of the IJCAI-99 Workshop on Automating the Construction of Case Based Reasoners. Stockholm, Sweden, 1999.Google Scholar
  8. 8.
    Kruusmaa, M. and Willemson, J. ‘Covering the Path Space: A Casebase Analysis for Mobile Robot Path Planning’. In: Bramer, M., Preece, A. and Coenen, F. (ed) Proceedings of ES2002. Springer-Verlag London, 2002, pp3–16Google Scholar
  9. 9.
    Leake, D., Smyth, B., Yang, Q. and Wilson, D. ‘Introduction to the Special Issue on Maintaining Case-Based Reasoning Systems’. Computational Intelligence, 2001; 17(2): 193–195CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2004

Authors and Affiliations

  • Daniel Kerr
    • 1
  1. 1.BUPA UK MembershipStainesUK

Personalised recommendations